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About The Trevor Project

Founded in 1998 by the creators of the Academy Award®-winning short film TREVOR, The Trevor Project is the leading national organization providing crisis intervention and suicide prevention services to lesbian, gay, bisexual, transgender and questioning (LGBTQ) young people ages 13–24.

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As a 501(c)3 non-profit, The Trevor Project relies on the generosity of friends to ensure that lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth have a safe place to turn in times of crisis.

GET HELP

Education

The Lifeguard Workshop is a free online learning module with a video, curriculum, and teacher resources for middle school and high school classrooms.

The Trevor Project’s Trainings for Professionals include in-person Ally and CARE trainings designed for adults who work with youth. These trainings help counselors, educators, administrators, school nurses, and social workers discuss LGBTQ-competent suicide prevention.

About The Trevor Project

Founded in 1998 by the creators of the Academy Award®-winning short film TREVOR, The Trevor Project is the leading national organization providing crisis intervention and suicide prevention services to lesbian, gay, bisexual, transgender and questioning (LGBTQ) young people ages 13–24.

Blogs & Events

Donate

As a 501(c)3 non-profit, The Trevor Project relies on the generosity of friends to ensure that lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth have a safe place to turn in times of crisis.

On behalf of The Leadership Conference on Civil and Human Rights, the National Health Law Program, the National Partnership for Women & Families, and the undersigned 163 organizations, we urge you to oppose any attempt to repeal the Affordable Care Act (ACA); slash federal funding and transform Medicaid into a block grant or per capita cap; eliminate the Medicaid expansion; and defund Planned Parenthood health centers.

Repealing the ACA, and restructuring and reducing the financing and coverage of Medicaid as proposed by the American Health Care Act (AHCA), would leave at least 23 million people in the United States, particularly people of color and underserved populations, significantly worse off than under current law. The ACA and Medicaid are critical sources of health coverage for America’s traditionally underserved communities, which our organizations represent. This includes individuals and families living in poverty, people of color, women, immigrants, LGBTQ individuals, individuals with disabilities, seniors, and individuals with limited English proficiency.

The ACA has reduced the number of people without insurance to historic lows, including a reduction of 39 percent of the lowest income individuals.i The gains are particularly noteworthy for Latinos, African Americans, and Native Americans. Asian Americans, Native Hawaiians and Pacific Islanders have seen the largest gains in coverage. The nation and our communities cannot afford to go back to a time when they did not have access to comprehensive, affordable coverage. Further, due to the intersectionality between factors, such as race and disability, or sexual orientation and uninsurance, and issues faced by women of color, many individuals may face additional discrimination and barriers to obtaining coverage. Proposals to replace the ACA with high-risk pools, Health Savings Accounts, or “cheaper” insurance plans that do not offer comprehensive, affordable benefits are unacceptable.

Medicaid is also critically important as it insures one of every five individuals in the United States, including one of every three children and 10 million people with disabilities.
Medicaid coverage, including the Medicaid expansion, is particularly critical for underserved individuals and especially people of color, because they are more likely to be living with certain chronic health conditions, such as diabetes, which require ongoing screening and services. People of color represent 58 percent of non-elderly Medicaid enrollees.ii According to the Kaiser Family Foundation, African Americans comprise 22 percent of Medicaid enrollment, and Hispanics comprise 25 percent.iii They are more likely than White non- Hispanics to lack insurance coverage and are more likely to live in families with low incomes and fall in the Medicaid gap.iv As a result, the lack of expansion disproportionately affects these communities, as well as women, who make up the majority of poor uninsured
gains in health coverage, this could mean vastly reduced access to needed health care, increased medical debt, and persistent racial disparities in mortality rates.v Further, Medicaid provides home and
community-based services enabling people with disabilities to live, work, attend school, and participate in their communities. The proposed cuts would decimate the very services that are cost-effective and keep individuals out of nursing homes and institutions. Finally, one in five people with Medicare rely on Medicaid to cover vital long-term home care and nursing home services, to help afford their Medicare premiums and cost-sharing, and more.

Despite the common myth that all low-income people could enroll in Medicaid, the Medicaid program has only been available to certain categories of individuals (e.g., children, pregnant women, seniors, people with disabilities) and had little to no savings or assets. Parents of children and childless adults were often excluded from Medicaid or only the lowest income individuals in these categories were eligible. For example, the Medicaid expansion greatly expanded coverage for LGBTQ individuals who previously did not fit into a traditional Medicaid eligibility category and for working people struggling in jobs that do not offer health insurance and pay at or near the minimum wage.

The CBO estimated that under the AHCA, as initially proposed, 14 million people would lose their Medicaid coverage by 2026, a reduction of about 17 percent relative to the comparable number under current law.vi The AHCA would end the higher federal matching rate for people newly enrolled through the Medicaid expansion and transform the financing from an entitlement program based on the number of persons enrolled to a more limited per capita-based cap or block grant. CBO estimates that by 2026, Medicaid spending would be reduced by $834 billion or 25 percent less than estimated under current law.vii This dramatic reduction in funding to the states is likely to result in more people losing coverage and/or needed services, particularly those optional services needed by people with disabilities.

Further, we are very concerned about the possibility of giving states an option under the Medicaid program to impose a work requirement as a condition of eligibility for the first time. Such a requirement not only fails to further the purpose of providing health care but also undermines this objective. Among adults with Medicaid coverage, nearly 8 in 10 live in working families and a majority are working themselves.viii

In addition, the AHCA would single out Planned Parenthood and block federal Medicaid funds for care at its health centers. The “defunding” of Planned Parenthood would prevent more than half of its patients from getting affordable preventive care, including birth control, testing and treatment for sexually transmitted diseases, breast and cervical cancer screenings, and well-women exams at Planned Parenthood health centers, often the only care option in their area. This loss of funds will have a disproportionate effect on poor families and people of color who make up 40 percent of Planned Parenthood patients.ix Seventy-five percent of Planned Parenthood patients are at or below 150 percent of the federal poverty level and half of their health centers are in rural or underserved areas.x

We are seriously concerned about the lack of transparency of the discussions taking place to develop this legislation. After more than seven years and 60 votes to repeal the ACA, there is no excuse for forcing consideration of this bill without adequate time for analysis, hearings, and discussion of a CBO score, providing ample opportunity for the public to understand the proposed legislation and participate in this discussion in which their very access to health care for themselves and their families is at stake.
funding guarantee into a block grant or per capita caps, and any attempts to defund Planned Parenthood. If you have any questions, please feel free to contact Leadership Conference Health Care Task Force Co- chairs Judith Lichtman at the National Partnership for Women & Families ([email protected]), Mara Youdelman at the National Health Law Program ([email protected]), or June Zeitlin at The Leadership Conference ([email protected]).

Sincerely,

The Leadership Conference on Civil and Human Rights National Health Law Program (NHeLP)
National Partnership for Women & Families ACCESS
Access Living
ADAP Advocacy Association (aaa+) Advocates for Youth
AFL-CIO AFSCME
AIDS Foundation of Chicago American Academy of Nursing
American Association of Colleges of Pharmacy
American Association of People with Disabilities (AAPD) American Association of University Women (AAUW) American Civil Liberties Union
American Federation of Teachers American Nurses Association
American-Arab Anti-Discrimination Committee Amida Care
Amnesty International USA APLA Health
Asian & Pacific Islander American Health Forum
Asian & Pacific Islander Caucus for Public Health (APIC)
Association of Asian Pacific Community Health Organizations (AAPCHO) Association of Programs for Rural Independent Living
Association of Reproductive Health Professionals Association of University Centers on Disabilities Autistic Self Advocacy Network
Bazelon Center for Mental Health Law Bend the Arc Jewish Action
Black Women’s Health Imperative
Black Women’s Roundtable, National Coalition on Black Civic Participation Breast Cancer Action
Cascade AIDS Project
Center for Community Change Action Center for Law and Social Policy (CLASP) Center for Medicare Advocacy
Center for Reproductive Rights
Coalition for Disability Health Equity Coalition of Labor Union Women
Colorado Organization for Latina Opportunity and Reproductive Rights (COLOR) Commission on the Public’s Health System
CommonHealth ACTION
Community Access National Network (CANN) Crescent City Media Group
Disability Rights Education and Defense Fund Drug Policy Alliance
EMILY’s List
Equal Justice Society Equal Rights Advocates Equality California Equality Federation Families USA
Family Equality Council Family Voices Farmworker Justice Feminist Majority
GLMA: Health Professionals Advancing LGBT Equality Health & Medicine Policy Research Group
Health Care for America Now (HCAN) Health Justice Project
Hispanic Health Network HIV Medicine Association Human Rights Campaign Human Rights Watch
Illinois Public Health Association Indivisible
International Association of Official Human Rights Agencies International Association of Women in Radio and Television, USA Jewish Council for Public Affairs
Jewish Women International Justice in Aging
Korean Community Services of Metropolitan NY Lambda Legal
Latino Commission on AIDS Latinos in the Deep South
Lawyers’ Committee for Civil Rights Under Law
LBGT PA Caucus of the American Academy of Physician Assistants, Inc. League of United Latin American Citizens
League of Women Voters of the United States
LEAnet, a national coalition of local education agencies LPAC
Main Street Alliance Medicare Rights Center
Movement Advancement Project
NAACP NAPAFASA NASTAD
National African American Drug Policy Coalition Inc.
National Association of County Behavioral Health and Developmental Disability Directors & National Association for Rural Mental Health
National Association of Human Rights Workers National Association of Social Workers National Black Justice Coalition
National Center for Learning Disabilities National Center for Lesbian Rights National Center for Transgender Equality National Collaborative for Health Equity
National Council of Asian Pacific Americans (NCAPA) National Council of Churches
National Council of Jewish Women National Council of La Raza
National Council on Independent Living National Disability Rights Network National Domestic Workers Alliance National Education Association National Employment Law Project
National Family Planning & Reproductive Health Association National Hispanic Medical Association
National Immigration Law Center National Institute for Reproductive Health
National Latina Institute for Reproductive Health National LGBTQ Task Force Action Fund National Low Income Housing Coalition
National Network for Arab American Communities (NNAAC) National Organization for Women
National Urban League
National Women’s Health Network National Women’s Law Center National Women’s Political Caucus
NETWORK Lobby for Catholic Social Justice
NOBCO: National Organization of Black County Officials OCA – Asian Pacific American Advocates
OneAmerica
Organizing for Action-Springfield Out2Enroll
People For the American Way Philadelphia Unemployment Project Planned Parenthood Federation of America PolicyLink
Population Institute
Positive Women’s Network – USA
Prevention Institute Prism Health
Progressive Leadership Alliance of Nevada Project Inform
Raising Women’s Voices for the Health Care We Need Resource Center
San Francisco AIDS Foundation
Service Employees International Union (SEIU)
Sexuality Information and Education Council of the U.S. (SIECUS) SisterSong: National Women of Color Reproductive Justice Collective SiX Action
TASH
The AIDS Institute
The Arc of the United States
The National Campaign to Prevent Teen and Unplanned Pregnancy The Trevor Project
The United Methodist Church – General Board of Church and Society Trust for America’s Health
UCHAPS: Urban Coalition for HIV/AIDS Prevention Services Union for Reform Judaism
United Church of Christ, Justice and Witness Ministries URGE: Unite for Reproductive & Gender Equity Venas Abiertas
Voices for Progress
Wisconsin Alliance for Women’s Health Women Employed
Women’s Action Movement
Women’s Intercultural Network (WIN) Women’s Media Center
Women’s Missionary Society African Methodist Episcopal Church Young Invincibles
YWCA USA

i U.S. Department of Health and Human Services, Affordable Care Act Has Led to Historic, Widespread Increase in Health Insurance Coverage, pp. 2, 4 (Sept. 29, 2016), available at https://aspe.hhs.gov/sites/default/files/pdf/207946/ACAHistoricIncreaseCoverage.pdf.
ii Kaiser Family Foundation, Medicaid Coverage Rates for the Nonelderly by Race/Ethnicity: 2015, available at http://kff.org/medicaid/state-indicator/rate-by-raceethnicity-3/?currentTimeframe=0.
iii Kaiser Health Foundation, Medicaid Enrollment by Race/Ethnicity, available at http://kff.org/medicaid/state- indicator/medicaid-enrollment-by-raceethnicity/.
iv Kaiser Family Foundation, The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand
Medicaid, http://kff.org/uninsured/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/ v Center on Budget and Policy Priorities, African Americans Have Much to Lose Under House GOP Health Plan, available at http://www.cbpp.org/blog/african-americans-have-much-to-lose-under-house-gop-health-plan.
vi Congressional Budget Office Estimate, American Health Care Act (March 13, 2017) available at https://www.cbo.gov/sites/default/files/115th-congress-2017-2018/costestimate/americanhealthcareact_0.pdf. vii Congressional Budget Office Estimate, American Health Care Act (May 24, 2017) available at https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/hr1628aspassed.pdf.
viii Kaiser Family Foundation, Understanding the Intersection of Medicaid and Work, available at http://files.kff.org/attachment/Issue-Brief-Understanding-the-Intersection-of-Medicaid-and-Work
ix Planned Parenthood, This is Who We Are, (July 11, 2016), available at https://www.plannedparenthood.org/files/6814/6833/9709/20160711_FS_General_d1.pdf
x Planned Parenthood, The Urgent Need for Planned Parenthood Health Centers (Dec. 7, 2016), available at https://www.plannedparenthood.org/files/4314/8183/5009/20161207_Defunding_fs_d01_1.pdf

The Honorable Chairwoman Darlene Mealy
Committee on Civil Rights
New York City Council

The Trevor Project writes in strong support of amendment T2017-6329, which would ban so-called “conversion therapy” in New York City. If passed, New York City would join the ranks of nine other states, including California and New Jersey, and nearly twenty cities that have demonstrated their commitment to the well-being of LGBTQ youth by passing similar laws. Conversion therapy is a dangerous and discredited practice which aims at changing one’s sexual orientation or gender identity. This “therapy” is done through methods which often include emotional, psychological and even physical abuse.[1] As the leading national organization providing crisis intervention and suicide prevention services to lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth, we know this bill is critical to creating supportive mental health care for LGBTQ people in New York City and saving many young people from the trauma of conversion therapy.

The Trevor Project works to save young lives through our accredited free and confidential lifeline; our secure instant messaging services which provide live help and intervention; our social networking community for LGBTQ youth; and our in-school workshops, educational materials, online resources, and advocacy. From August 1, 2016 to June 13, 2017, The Trevor Project has had almost 4,500 crisis contacts in New York State. While we are unable to track contacts by city, we know that hundreds of New York City LGBTQ youth struggling with suicidal thoughts are reaching out to us every year.

Banning conversion therapy can be a matter of life or death for many young people. Research shows that LGB youth seriously contemplate suicide at almost three times the rate of heterosexual youth and LGB youth are almost five times as likely to have actually attempted suicide.[ii] In a national study, 40% of transgender adults reported having made a suicide attempt at some point in their lives. 92% of these individuals reported having attempted suicide before the age of 25.[iii] Suicide is the third leading cause of death for youth in New York ages 15-24,[iv] with a suicide rate of 6.7 deaths for every 100,000 young people.[v] Studies show that for every one person who dies by suicide, there are 25 attempts.[vi]

Perhaps most importantly, youth placed in conversion therapy are at an even greater risk. For example, LGBTQ youth from highly rejecting families are more than eight times as likely to attempt suicide compared to those from accepting families.[vii] Families that are extremely rejecting of their child’s sexual orientation or gender identity are among those most likely to send their child to conversion therapy. Evidence also shows conversion therapy poses serious health risks including depression, shame, decreased self-esteem, social withdrawal, substance abuse, risky behavior and suicidal ideation.[viii] Passing this ordinance will help ensure no more young people suffer from the harms of conversion therapy or lose their life to this abuse.

Additionally, there is no scientific evidence to show conversion therapy is effective in its goal of changing one’s sexual orientation or gender identity.[ix] The nation’s leading mental health associations including the American Psychiatric Association, the American Psychological Association, the American Counseling Association, the National Association of Social Workers, the American Academy of Pediatrics, and the American Association for Marriage and Family Therapy have all issued statements condemning the practice.[x] As the nation’s only accredited, 24/7 lifeline specifically for LGBTQ youth, we hear from conversion therapy survivors and bear witness to the devastating impacts of this practice. No young person should have to endure the damage done by supposed members of helping professionals or religious institutions.

By supporting this proposed law, you can be a part of ending this abuse and ensuring that LGBTQ youth in New York City can truly have a bright future.
Learn about Trevor Project advocacy programs here.

(Washington, June 13, 2017) – Today U.S. Representative Sean Patrick Maloney reintroduced a bill to Provide a Requirement to Improve Date Collection Efforts, also known as the LGBT PRIDE Act, which will improve our understanding of the relationship between LGBTQ individuals and suicide.

The bill directs the Centers for Disease Control and Prevention to enhance the collection of sexual orientation and gender identity data for deceased individuals, including those who died by suicide. Currently national surveillance endeavors including the National Violent Death Reporting System do not collect sexual orientation or gender identity information on decedents, leaving an enormous gap in our knowledge of the number of LGBTQ youth who die by suicide. The idea for the bill was conceived during a legislative briefing by The Trevor Project on LGBTQ youth suicide last year. Once Rep. Maloney learned of this inequality he quickly set out to draft the PRIDE Act to correct it.

From the office of Rep. Sean Patrick Maloney (NY-18), Co-Chair of the Congressional LGBT Equality Caucus: “One year after the deadly shooting at Orlando’s Pulse nightclub, Representative Sean Patrick Maloney (NY-18), New York’s first openly gay member of Congress, announced the introduction of the bill to improve data collection on the sexual orientation and gender identity of victims of violent crimes. Rep. Maloney’s LGBT PRIDE (Provide a Requirement to Improve Date Collection Efforts) Act calls on CDC to improve the process, and authorizes $25 million to fund the effort.

Although the overwhelming majority of victims of the Pulse shooting were LGBTQ, the federal government’s National Violent Death Reporting System (NVDRS) collects only a small amount of information on sexual orientation and gender identity. This means the lives lost in the Orlando attack were not recorded as anti-LGBT murders in any data collection.

Pulse wasn’t an isolated occurrence – anti-LGBTQ violence is way too common – it happens when a transwoman of color is gunned down in the street, it happens when a young gay person is bullied into depression or takes his own life. “We have to get more information on where this violence is happening and we have to be more aggressive about doing something to stop it – and this bill is a necessary first step.”

“No American should ever feel like they are treated less than equal. It’s on all of us to continue fighting until we make this a reality. The LGBT PRIDE Act will authorize $25 million to expand data collection on sexual orientation and gender identity through the CDC’s National Violent Death Reporting System. This data is critical for identifying the causes of violent crime, and developing new, strategic methods to stop it. I’m proud to join Congressman Maloney in introducing this important bill today,” said Rep. David Cicilline, Co-Chair of the Congressional LGBT Equality Caucus.

“This legislation will play a critical role helping us to better understand and help end LGBTQ youth suicide,” said Trevor Project CEO Amit Paley. “Currently no one is able to answer the question of how many LGBTQ individuals die by suicide every year. This is a monumental gap in our knowledge of suicide and keeps us from most effectively targeting prevention and intervention efforts. The saying often goes ‘if you’re not counted then you don’t count’, and it’s time to finally acknowledge the importance of LGBTQ lives and get the data to help save those lives.”

The LGBT PRIDE Act would require the CDC to improve its data collection on sexual orientation and gender identity and authorize $25 million to fund the effort. The system currently has the ability to collect data on sexual orientation and gender identity, but various barriers exist to comprehensive collection. The NVDRS aggregates data from a variety of local sources including death certificates, coroner/medical examiner reports, police reports, and crime labs. This data is used to inform policy and regulatory decisions aimed at responding to public health crises such as suicide and homicide at the local, federal, and state level. All data collection is performed on a voluntary basis, and the results are only released in aggregate to protect the privacy of decedents.

Amy Loudermilk, Trevor Project Director of Government Affairs said, “We know LGBTQ youth have disproportionately higher rates of suicide attempts, but what we don’t know is if that extends to disproportionate rates of death by suicide. In order to prevent suicide deaths and save young lives this data is of vital importance.”

Loudermilk spoke at this morning’s press conference with Representative Maloney at the United States Capitol. Below are her remarks:

“Good Morning. My name is Amy Loudermilk and I’m the director of government affairs at The Trevor Project, the leading national organization providing crisis intervention and suicide prevention services to LGBTQ youth. At The Trevor project, we are experts on the issue of LGBTQ youth suicide and have over 50,000 crisis contacts with youth every year. I routinely talk about the disproportionate risk LGBTQ young people have for suicide attempts. For example, LGB youth attempt suicide at four times the rate as straight youth, and a recent survey found that 40% of transgender adults reported attempting suicide, with 92% of those attempting before the age of 25. What I can’t tell you though, is how many LGBTQ youth die by suicide in each year. No one can answer that question because neither sexual orientation nor gender identity data is routinely collected when someone dies from a violent death. Rep. Maloney’s PRIDE Act will change that.

Did you know that since 2000 motor vehicle related fatalities have decreased 35-40%? A number of factors contributed to this, including: laws against texting or talking on the phone while driving; zero tolerance for drunk driving; child car seat laws and helmet laws. The impact public policy can make is truly impressive and in this case lifesaving. But right now it’s as if we’re in the dark ages of LGBTQ suicide prevention because we don’t even have a baseline number of deaths from which to assess the effectiveness of interventions or appropriately target resources.

This landmark piece of legislation signals a fundamental change in the way information about violent deaths, including suicide and homicide, are recorded and reported. It also communicates a key message to LGBTQ youth: their lives matter. We can only get better at saving lives if we have data about who is most at risk. The Trevor Project is incredibly grateful to Rep. Maloney and his staff for introducing this bill and helping to obtain the data necessary to move the field of suicide prevention into the light so we can continue to help shed light on this issue and provide support to LGBTQ youth in crisis.”

#LGBTQLivesCount

About the Trevor Project:
The Trevor Project is the leading and only accredited national organization providing crisis intervention and suicide prevention services to lesbian, gay, bisexual, transgender and questioning (LGBTQ) young people under the age of 25. The Trevor Project offers a suite of crisis intervention and suicide prevention programs, including TrevorLifeline, TrevorText, and TrevorChat as well as the world’s largest peer-to-peer social support network for LGBTQ young people under the age of 25, TrevorSpace. Trevor also offers an education program with resources for youth-serving adults and organizations, a legislative advocacy department fighting for pro-LGBTQ legislation and against anti-LGBTQ rhetoric/policy positions, and conducts research to discover the most effective means to help young LGBTQ people in crisis and end suicide. If you or someone you know is feeling hopeless or suicidal, our Trevor Lifeline crisis counselors are available 24/7/365 at 1-866-488-7386. www.TheTrevorProject.org

The undersigned 59 Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ), American Muslim, and Latinx organizations released the following statement in advance of the first day of remembrance of the June 12, 2016 massacre at the LGBTQ nightclub Pulse in Orlando, Florida. The statement was convened by national civil rights organizations including Muslim Advocates, the National LGBTQ Task Force, the National Council of La Raza (NCLR), the Human Rights Campaign (HRC), and the League of United Latin American Citizens (LULAC):

“One year ago, in the aftermath of the Orlando tragedy, we came together in grief, in unity, and in solidarity with the Orlando community and millions of people everywhere, to condemn this act of hate violence and affirm that love conquers hate. That senseless act struck at the heart of the LGBTQ and Latinx communities, families, and close friends, and at the core of one of our nation’s greatest strengths: our diversity. The ensuing backlash against the American Muslim community led to hate speech and violence, shootings, and mosque vandalism that claimed even more victims.
The acts of kindness that followed also illustrated that, even in our darkest moments, and despite the repeated attempts to use fear to further divide us, time and time again, the people of this country come together to console and support those in need.

As we remember those we lost and their families, we renew our commitment to honor them with action by protecting one another and our country’s ideals of freedom, liberty, and equality under the law for all people.
This day of remembrance comes during LGBTQ Pride Month and the holy month of Ramadan. As we reflect on the past year, we are deeply concerned about the direction of our country including efforts to divide Americans from one another by demonizing and scapegoating many of our communities–but we are also proud of the millions of Americans of all faiths, races, ethnicities, sexual orientations, gender identities, and backgrounds who continue to rebuff those attempts by stepping up to defend our highest ideals.

We have been reminded countless times that a threat against any one community is a threat against all of us, and that we must take notice and action. As our communities resist a massive rollback of civil rights protections at the state and federal level and a rising tide of hate violence, we stand together ever stronger, ever braver, and ever more resolute to resist these attacks and move forward with love and acceptance for all.”

Dear Leader McConnell and Leader Schumer,
The undersigned organizations are writing to share our views on critical provisions we believe must be included in any legislation modifying the nation’s health care system. We also want to share serious concerns with several of the reforms included in the House-passed American Health Care Act (AHCA).

We collectively represent consumers, families, providers, health care and social service professionals, criminal justice professionals, advocates and allied organizations who are committed to meaningful and comprehensive policies to reduce the toll of substance use disorders and mental illness through prevention, treatment and recovery support services.

We recognize that the current law can be improved and that there are problems that need to be fixed. However, we do not support changes to the health care system that would result in reduced access to substance use disorder and mental health treatment, including changes that would cap federal funding for Medicaid, end the Medicaid expansion, and eliminate benefit protections for Americans insured through the small group and individual markets. In the face of the opioid overdose and suicide epidemics, equitable access to a full continuum of mental health and substance use disorder treatment services, including medications to treat substance use disorders and mental illness, must be an essential component of health care coverage. It is also critical that substance use disorders and mental illness be covered on par with other medical conditions consistent with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).

As the Senate takes up health reform legislation, we ask that the Senate bill:

Maintain benefit protections for mental health and substance use disorder treatment and recovery support services through the exchanges and individual/small group markets, and maintain requirements that those benefits be offered at parity with medical benefits

Maintain Medicaid’s current financing structure, including the Medicaid expansion

More than 20 million Americans currently have health care coverage due to the Affordable Care Act (ACA), including millions of Americans with substance use disorders and mental illness. This coverage is a critical lifeline for these individuals, many of whom were unable to access effective treatment before the ACA’s expansion of Medicaid eligibility to low-income adults, and its requirement that Medicaid expansion plans and plans sold in the individual and small group markets cover substance use disorder and mental health treatment services at parity with medical and surgical services.

The Medicaid expansion in particular has led to significant increases in coverage and treatment access for persons with substance use disorders and mental illness. In states that expanded Medicaid, the share of people with substance use disorders or mental illness who were hospitalized but uninsured fell from about 20 percent in 2013 to 5 percent by mid-2015, and Medicaid expansion has been associated with an 18.3 percent reduction in the unmet need for substance use disorder treatment services among low-income adults. Rolling back the Medicaid expansion and/or fundamentally changing Medicaid’s financing structure to cap spending on health care services will certainly reduce access to evidence-based treatments and reverse much or all progress made on the opioid crisis last year. Moreover, the loss of Medicaid-covered mental health and
substance use disorder services for adults would result in more family disruption and out-of-home placements for children, significant trauma which has its own long-term health effects and a further burden on a child welfare system that is struggling to meet the current demand for foster home capacity.

Medicaid funding for mental health and substance use disorder treatment services for low-income populations must be predictable, sustainable, and integrated with financing mechanisms for general medical care to ensure consistent access to treatment and support the long-term development and retention of a substance use disorder and mental health clinician workforce. Capping federal Medicaid funding through per-capita caps or block grants would strain state budgets and likely force states to cut benefits, lower provider reimbursement rates, and/or limit access to care. These changes would be devastating to states grappling with the current opioid overdose and suicide epidemics.

The ACA’s Medicaid expansion, Essential Health Benefit requirements for mental health and substance use disorder treatment coverage, and extension of parity protections to the individual and small group market have surely reduced the burden of the opioid misuse and overdose and suicide epidemics and saved lives. As you consider this legislation, we ask that you ensure substance use disorder and mental health treatment benefits continue to be available to Americans enrolled in the individual, small and large group markets as well as Medicaid plans and that these benefits are compliant with the Mental Health Parity and Addiction Equity Act.

Finally, throughout this process, we implore you to keep in mind how your decisions will affect the millions of Americans suffering from substance use disorders and mental illness who may lose their health care coverage entirely or see reductions in benefits that impede access to needed treatment.

Today, on the National Day of Prayer, President Trump signed an Executive Order directing Attorney General Jeff Sessions to “issue guidance interpreting religious liberty protections in Federal law.” Sessions is known for his strong anti-LGBT equality policies. Many people were previously aware that Trump was likely to sign an executive order dealing with so-called “religious liberty,” which we know is nothing but a license to discriminate, particularly against the LGBTQ+ community.

In his remarks, Trump said, “With this Executive Order we make clear that the federal government will never ever penalize any person for their protected religious beliefs… that’s why I am directing the Department of Justice to develop new rules to ensure these religious protections are afforded to all Americans… that is why I am signing an Executive Order to defend the freedom of religion and speech in America.”

Trump’s signed order did not provide any new religious freedom protections that would specifically allow individuals to discriminate against LGBTQ individuals, but it did, however, direct the Department of Justice to develop rules to ensure that people aren’t punished for exercising their freedom of religion. “In reality this means that although Trump didn’t issue a broad “religious freedom” order aimed at the LGBTQ+ community, he essentially directed the Department of Justice to do so through regulations,” said Trevor Project Director of Government Affairs Amy Loudermilk. “In sum, the fight is far from over and the rhetoric about what to expect down the line is very concerning. We will continue to monitor and respond as necessary.”

The Trevor Project is committed to continuing to work with our LGBTQ and allied organizational colleagues across the country, and we will stand strong against any future negative actions against our community.

The Trevor Project is the leading and only accredited national organization providing crisis intervention and suicide prevention services to lesbian, gay, bisexual, transgender and questioning (LGBTQ) young people under the age of 25. The Trevor Project offers a suite of crisis intervention and suicide prevention programs, including TrevorLifeline, TrevorText, and TrevorChat as well as a peer-to-peer social network support for LGBTQ young people under the age of 25, TrevorSpace. Trevor also offers an education program with resources for youth-serving adults and organizations, a legislative advocacy department fighting for pro-LGBTQ legislation and against anti-LGBTQ rhetoric/policy positions, and conducts research to discover the most effective means to help young LGBTQ people in crisis and end suicide. If you or someone you know is feeling hopeless or suicidal, our Trevor Lifeline crisis counselors are available 24/7/365 at 1-866-488-7386. www.TheTrevorProject.org

The Trevor Project, the leading national organization providing crisis intervention and suicide prevention services to lesbian, gay, bisexual, transgender and questioning youth (LGBTQ) writes to strongly urge you to vote against HB 609, the Montana Locker Room Privacy Act. Many organizations are weighing in on the devastating impacts this bill will have on transgender youth, but it is also critically important that you consider the public health impact this bill will have on the transgender youth of Montana.

The Trevor Project serves youth under 25 and works to save young lives through our accredited free and confidential lifeline, secure instant messaging services which provide live help and intervention, a social networking community for LGBTQ youth, in-school workshops, educational materials, online resources, and advocacy.

Unfortunately, there is a great need for an organization such as Trevor. Lesbian, gay and bisexual youth are four times more likely to attempt suicide than their straight peers. (i) While this alone is shocking enough, it pales in comparison to the statistics regarding transgender youth. In a recent national survey, 40% of transgender adults reported having made a suicide attempt. 92% of these individuals reported having attempted suicide before the age of 25. (ii)

There are many factors that contribute to the high suicide rate for transgender youth: lack of understanding and awareness from others: the rejection of family and friends; bullying; mental health challenges; discrimination and societal stigmatization. If HB 609 is allowed to become law, this ostracizing policy will become one more brick on the backs of transgender youth who are already on the verge of collapsing from too much weight.

Not being allowed to use the restroom or locker room consistent with one’s gender identity can cause significant psychological and social distress. In fact, research has shown a high correlation between transgender young people being denied the right to use the appropriate bathroom and suicidality. (iii) The spread of knowledge that a young person is transgender by others because one requests a reasonable accommodation can lead to severe bullying and violence, including homicide. Every year in the United States, transgender individuals are killed simply because of who they are. This year alone at least eight transgender individuals have been murdered in the United States. (iv) Living one’s life as a transgender individual is brave, but it’s also very risky.

Many cities and states have laws explicitly allowing transgender individuals to use the restroom consistent with their gender identity. (v) Since the passage of those laws there hasn’t been a single case of a person posing as a transgender individual to gain access to a restroom for the purpose of carrying out a sexual assault. (vi) Therefore, the idea behind this bill to “protect” children was actually built on a false premise and passing it does nothing to help protect students from predators. In addition, as discussed above, allowing this bill to pass may cause significant suffering for transgender youth in Montana. This should be of particular concern for legislators because Montana currently has the third highest rate of suicide deaths of all fifty states. In 2015, the most current year for which we have data, Montana had a total of 272 deaths by suicide. The national average of suicide deaths is 13.8 per 100,000 residents, Montana’s is 26.3, almost double that of the national average. (vii) In the past year, Trevor has had almost 200 calls, chats and texts from youth in Montana that include transgender youth in mental health crises or youth who were struggling with suicidal ideation. We don’t want the sometimes fragile mental health of transgender youth to possibly be made any worse through public policy that actively discriminates and ostracizes them.

In order to ameliorate this serious public health issue facing Montana, we strongly urge you to vote against HB 609. Should you have any questions or comments please contact Amy Loudermilk, Associate Director of Government Affairs at
or 202-391-0834.

The undersigned national advocacy organizations, representing the interests of lesbian, gay, bisexual and transgender (LGBT) people and people living with HIV, oppose the nomination of Judge Neil Gorsuch to be an Associate Justice on the United States Supreme Court. After a comprehensive review of Judge Gorsuch’s record, we have concluded that his views on civil rights issues are fundamentally at odds with the notion that LGBT people are entitled to equality, liberty, justice and dignity under the law.

We wish to call to your attention the following aspects of Judge Gorsuch’s record and philosophy that are of particular concern to our organizations and our constituents, and that raise crucial questions of grave consequence to LGBT people, everyone living with HIV, and anyone who cares about these communities.

The Dangers of “Originalism.” Judge Gorsuch professes to be an “originalist.” (1) This philosophy treats the Constitution as frozen in time, meaning that, unless the Constitution has been amended to explicitly protect certain rights, individuals have no more rights today than they did in 1789. (2) This philosophy essentially writes LGBT people out of the Constitution. A few examples of how Judge Gorsuch’s approach would manifest itself in specific areas of the law illustrate why we believe that Judge Gorsuch poses such a grave threat to our community:

Fundamental Rights. We are concerned that Judge Gorsuch’s writings, including his book on assisted suicide, (3) reveal his open hostility toward the very existence of constitutionally protected fundamental rights. No one can read that book and come away with any reasonable doubt that Judge Gorsuch is deeply skeptical that our Constitution protects any fundamental rights beyond those expressly enumerated in the Bill of Rights. Among these unenumerated, yet well-established, fundamental rights are the rights to privacy, autonomy and self-determination, the right to parent, the right to procreative freedom, the right to engage in private consensual adult relationships, and the fundamental right to marry.

Although these rights are important to everyone, they are essential for the LGBT community. These are the rights that have been the lynchpin of our legal progress and that underlie the series of decisions—from Lawrence to Windsor to Obergefell (4) —that have transformed the place of LGBT people in our society. Based on his extensive record, there can be no doubt that, had he been on the Court, Judge Gorsuch would have rejected each of these basic rights. Indeed, as discussed further below, he has been openly critical of same-sex couples for even seeking to vindicate their constitutional rights, including the right to marry, through litigation.

We urge the Committee to press Judge Gorsuch to explain on his views about fundamental rights. For example:

Does he believe that there is a fundamental right to privacy, and if so, does the right as he understands it protect consensual adult sexual relationships?

Does he believe that the Constitution protects a fundamental right to marry? The right to access contraception? The right to decide whether to continue a pregnancy?

Judge Gorsuch’s articulated judicial philosophy is far outside the legal and social mainstream, and would significantly disrupt Americans’ expectations about the rights that they enjoy under the Constitution. His views should be as frightening to others as they are to the LGBT community. The Committee should require Judge Gorsuch to explain what he means when he describes himself as an “originalist.”

Equal Protection. An originalist view is hostile to the notion that laws targeting historically disfavored groups warrant any form of heightened scrutiny, with the exception of laws that discriminate on the basis of race. Because, in his view, the drafters of the Fourteenth Amendment did not intend to prohibit sex discrimination, Justice Scalia ￼regularly voted against heightened constitutional protections for women. (5)

Judge Gorsuch has praised Justice Scalia, and presumably shares the late Justice’s view that laws targeting women for discrimination should receive nothing more than so-called “rational basis review.” In a 2016 article, Judge Gorsuch praised Justice Scalia’s approach to equal protection, and agreed that “judges should . . . strive (if humanly and so imperfectly) to apply the law as it is, focusing backward, not forward, and looking to text, structure, and history to decide what a reasonable reader at the time of the events in question would have understood the law to be.” (6)

The suggestion that sex-based classifications should not trigger heightened judicial scrutiny discrimination is far outside the mainstream, and has been rejected by the Supreme Court on numerous occasions. (7) If Judge Gorsuch adheres to Justice Scalia’s view that laws discriminating on the basis of gender should not be subjected to heightened scrutiny, then Judge Gorsuch would certainly find nothing wrong with laws that single out LGBT people for discrimination, so long as someone somewhere could conjure up some other reason for passing such a law.

On numerous occasions, the Supreme Court has struck down laws that were passed to make LGBT people “strangers to the law”—an anti-gay ballot initiative in Colorado,8 discriminatory state marriage laws, (9) and a federal law prohibiting recognition of same- sex couples’ marriages. (10) What level of scrutiny would an “originalist” like Judge Gorsuch apply to such laws? Judge Gorsuch should be asked to state his views on the record and required to explain how this approach can possibly be squared with existing Supreme Court precedents striking down laws that single out LGBT people for harmful, unequal treatment.

Role of Courts. Compounding the damage that would result from such a narrow view of the Constitution, Judge Gorsuch has expressed disapproval of people resorting to the courts at all to vindicate their civil rights. For example, in 2005, Judge Gorsuch wrote that “American liberals have become addicted to the courtroom . . . as the primary means ￼of effecting their social agenda on everything from gay marriage” to other issues. (11) He has also called private civil rights litigation “bad for the country.” (12) How can any members of historically persecuted groups, including LGBT people, have confidence that Judge Gorsuch would approach their specific cases with an open mind? The Committee should press these issues in the hearing, as this appointment would last long beyond the term of this particular President. Rather, the damage that could be done by this nominee could span generations.

In numerous other areas as well, Judge Gorsuch poses a significant threat to the LGBT community. In fact, his views are even more extreme and outside the mainstream than Justice Scalia’s, whom Judge Gorsuch is proposed to replace.

Approach to Statutory Construction. Justice Scalia was a strict textualist, which meant he viewed as irrelevant whether Congress intended a particular understanding and application of the law. Instead, he focused simply on the words of the law as written. Consequently, Justice Scalia found that Title VII’s prohibition on sex discrimination applies to same-sex sexual harassment even though “male-on-male sexual harassment in the workplace was assuredly not the principal evil Congress was concerned with when it enacted Title VII.” (13) Justice Scalia also observed, “[S]tatutory prohibitions often go beyond the principal evil to cover reasonably comparable evils, and it is ultimately the provisions of our laws rather than the principal concerns of our legislators by which we are governed.” (14)

As set forth in the letters of other civil rights groups, Judge Gorsuch has taken an extremely narrow view of civil rights laws. (15) Indeed, one Stanford Law Review article analyzing his civil rights jurisprudence concluded:

Judge Gorsuch presents himself as a restrained judge. But that “restraint” often translates to extreme results when applied to legal rights open to interpretation. By attempting to hew to the narrowest reading of rights- creating text, Judge Gorsuch creates new understandings of the law, leaving litigants with limited access to courts and restricting the reach of constitutional and statutory protections. (16)

Although he claims to be an adherent of Justice Scalia’s philosophy, would Judge Gorsuch agree that laws like Title VII “often go beyond the principal evil to cover reasonably comparable evils,” or would he, true to his Court of Appeals record, adopt an artificially narrow reading of the statute’s text in order to achieve his preferred, backwards-looking policy outcome? The Committee should press him on this point, as the civil rights of millions of Americans hang in the balance.

Religious Exemptions from Laws that Someone Believes Would Make Them “Complicit” in Actions of Others. In Employment Division v. Smith, Justice Scalia wrote that the First Amendment has never given individuals a right to opt out of laws that, in their view, burden their exercise of religion. (17)

Yet, in his 10th Circuit decision in Hobby Lobby, Judge Gorsuch insisted instead that any individual should be able to opt out of any law that, in that person’s view, makes them “complicit” in conduct of another considered to be immoral, regardless of how compelling the state’s interest in enforcing the law. (18) In Hobby Lobby, that meant a large for-profit corporation could ignore the requirement in the Affordable Care Act that employer-provided health insurance for employees must include coverage for birth control among basic care options. Fortunately, the Supreme Court did not adopt Judge Gorsuch’s extreme approach, and made clear that an individual’s claim of religious liberty may not “unduly restrict other persons, such as employees, in protecting their own interests, interests the law deems compelling.” (19)

The Committee should interrogate Judge Gorsuch on his position in this area, as his views on “religious complicity” go well beyond anything that currently exists in American jurisprudence. For example:

Does employer-provided health care that includes infertility care make an employer “complicit” in a decision of a non-married couple to have children out of wedlock?

Would a law requiring that gender transition-related health care not be excluded from employee health plans make the employer “complicit” in an employee’s decision to undertake a gender transition?

Does providing health insurance coverage for an employee’s same-sex spouse make an employer “complicit” in that employee’s same-sex relationship?

Does providing coverage for medications such as PrEP, which prevents HIV infection, make an employer “complicit” in the employee’s private sexual conduct?

The American people are entitled to know more about Judge Gorsuch’s views on these subjects, so that they can understand how his approach could potentially impact their rights and their daily interactions with employers, physicians, and other service providers.

Finally, there are other areas where Judge Gorsuch’s views appear to be far outside the mainstream, and to warrant vigorous inquiry:

Relevance of Science to Legal Decision-Making. Judge Gorsuch signed onto an opinion holding that a transgender woman in prison whose hormone therapy was interrupted did not suffer irreparable harm. (20) And yet that conclusion flies in the face of the internationally-recognized Standards of Care of the World Professional Association of Transgender Health. (21) We would urge the Committee to ask Judge Gorsuch to clarify whether and when he thinks that medical or social science standards are relevant to legal decision-making. For example:

Would Judge Gorsuch credit the three decades of social science scholarship confirming the parenting skills of LGBT people, or would he disregard these facts?

What about current public health understanding of how HIV is transmitted? Would Judge Gorsuch require some basis in fact for state laws concerning HIV transmission, or would he allow states to legislate based on fear and ignorance?

The Committee should insist that Judge Gorsuch explain his judicial philosophy in general on this question and how he would approach these and similar cases.

Employer Defenses to Claims of Discrimination. Numerous other groups have identified examples of Judge Gorsuch’s reluctance to enforce civil rights laws that protect workers. (22) One example in particular raises unique concerns for our community. In Kastl v. Maricopa County Community College District, (23) Judge Gorsuch signed onto an opinion rejecting a transgender woman’s claim of discrimination. In that case, the school denied her access to the women’s restroom, and claimed that it had a non-discriminatory reason for doing so unrelated to her “sex”—“safety concerns” due to the discomfort-based complaints of other students.

The notion that the discomfort of co-workers or customers is sufficient to defeat a claim of discrimination is not only incorrect, it is wholly inconsistent with decades of jurisprudence. (24) The suggestion that vague concerns about “safety,” privacy” or “discomfort” could be enough to satisfy an employer’s burden of proof in a discrimination case not only suggests a hostility to victims of discrimination generally, but also undermines any confidence that one might have that an LGBT person could receive a fair hearing before Judge Gorsuch. The Committee should insist that Judge Gorsuch answer these and other important questions about his approach to labor and employment law.

The American people have a right to know how the appointment of Judge Gorsuch to the Supreme Court would impact the rights of LGBT Americans, people living with HIV, and other at-risk communities who are entitled to rely upon the Constitution’s guarantees of equality, liberty, dignity and justice under the law. We urge the Committee to demand complete answers from Judge Gorsuch to the important questions that we and others have raised. Only by insisting that Judge Gorsuch answer these questions will the Committee fulfill its responsibility to the American people, and reveal the extent to which his nomination jeopardizes rights and liberties that many Americans believe are secure.

2 See Erwin Chemerinsky, What Could Gorsuch Mean for the Supreme Court?: A backward jurist, POLITICO (Feb. 1, 2017), available at http://www.politico.com/magazine/story/2017/02/neil-gorsuch-supreme-court-future-214724 (“Under originalism, no longer would there be constitutional protection for privacy, including reproductive freedom, or a right to marriage equality for gays and lesbians, and or even protection of women from discrimination under equal protection. None of these rights were intended by the framers.”).

21 WORLD PROF’L ASS’N FOR TRANSGENDER HEALTH, STANDARDS OF CARE FOR THE HEALTH OF TRANSSEXUAL,
TRANSGENDER, AND GENDER NONCONFORMING PEOPLE 68 (7th ed. 2012) (“The consequences of abrupt withdrawal of hormones or lack of initiation of hormone therapy when medically necessary include a high likelihood of negative outcomes such as surgical self-treatment by autocastration, depressed mood, dysphoria, and/or suicidality.”).

22 See, e.g., Leadership Conference letter, supra note 15.

23 325 F. App’x 492, 493 (9th Cir. 2009).

24 See, e.g., Palmore v. Sidoti, 466 U.S. 429 (1984) (“Private biases may be outside the reach of the law, but the law cannot, directly or indirectly, give them effect”).

The Mental Health Liaison Group (MHLG) wishes to express serious concern about recent proposals that would restructure the long-standing and fundamental federal-state financing partnership of the Medicaid program. Such efforts could adversely impact the 14 million vulnerable people living with mental or substance use disorders who depend heavily on Medicaid coverage.

The MHLG is a coalition of more than 60 national organizations representing consumers, family members, mental health and substance use treatment providers, advocates, payers, and other stakeholders committed to strengthening Americans’ access to mental health and substance use services and programs. We urge you to continue to protect vulnerable Americans’ access to vital mental health and substance use disorder care and programs by not reversing the progress we have made with the recent enactment of key mental health reforms in the 21st Century Cures Act and earlier reforms, such as the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPEA) of 2008.

The importance of Medicaid coverage for people living with mental or substance use disorders cannot be overstated. Medicaid is the single largest payer for behavioral health services in the United States, accounting for about 26 percent of behavioral health spending, and is the largest source of funding for the country’s public mental health system. One in five of Medicaid’s nearly 70 million beneficiaries have a mental or substance use disorder diagnosis.

Medicaid covers a broad range of behavioral health services at low or not cost, including but not limited to psychiatric hospital care, residential treatment for children, case management, day treatment, evaluation and testing, psychosocial rehabilitation (which includes supported employment, housing, and education), medication management, school-based services as well as individual, group and family therapy. In three dozen states, Medicaid covers essential peer support services to help sustain recovery. Because people with behavioral health disorders experience a higher rate of chronic physical conditions than the general population, Medicaid’s coverage of primary care helps them receive treatment for both their behavioral health disorders and their physical conditions.

The state Medicaid expansion has proven to be crucial for low-income adults living with mental and substance use disorders. About 29 percent (3 million people) of low-income persons who receive health insurance coverage through the state Medicaid expansion program have a mental or substance use disorder. In states that have expanded Medicaid and which have been particularly hard hit by the opioid crisis, such as Kentucky, Pennsylvania, Ohio, and West Virginia, Medicaid pays between 35 to 50 percent of medication-assisted treatment for substance use disorders.

We now know that early access to mental health and substance use disorder services is essential to reducing the incidence and severity of these disorders. We also know that treating these disorders is a key factor in reducing the nation’s overall health care costs and the incidence of adverse encounters with the criminal justice system and homelessness, as well as in keeping people both in school and employed. Medicaid enables low-income people with mental or substance use disorders to receive care when they need it rather than waiting until there is a crisis, thus enabling them to lead healthier lives as fully participating members of our communities.

Recognizing Medicaid’s vital role in bringing mental health and substance use services to vulnerable populations, we are deeply concerned about recent proposals to block grant or cap the federal share of Medicaid. These models would dramatically restructure Medicaid’s joint federal-state financing partnership and the federal government’s guarantee of matching funds to states for qualifying Medicaid expenditures. Although details of current proposals have not yet been released, based on past proposals, we believe that converting Medicaid into a block grant or a per capita cap would shift significant costs to states up front, and over time. Experts have forecasted a 30 to 40 percent cut in the federal share of Medicaid over 10 years (Sperling, New York Times, December 25, 2016). Ultimately, states will be forced to reduce their Medicaid rolls, benefits, and already low payment rates to an already scarce workforce of behavioral health providers. Mental health and substance use disorder treatments and programs will be at high risk.

If states are forced to limit enrollment, eliminate covered benefits, and cut provider rates, we also believe that this will lead to substantial job losses in the behavioral health care industry. Such job losses could lead to additional unemployment, followed by additional reliance on public safety net programs, such as Medicaid.

The MHLG believes that the integrity of the Medicaid program must be preserved and that much can be achieved through more targeted reforms, such as the types of reforms we supported in the recently enacted 21st Century Cures Act. These included, for example, mental health prevention in the very young, early intervention, and care coordination and integration. We stand ready to work with you to promote these types of targeted reforms throughout the Medicaid program.

Sincerely,

American Art Therapy Association
American Association of Child and Adolescent Psychiatry
American Association for Geriatric Psychiatry
American Association on Health and Disability
American Counseling Association
American Dance Therapy Association
American Foundation for Suicide Prevention
American Group Psychotherapy Association
American Nurses Association
American Occupational Therapy Association
American Psychiatric Association
American Psychological Association
American Society of Addiction Medicine
Anxiety and Depression Association of America
Association for Ambulatory Behavioral Healthcare
Campaign for Trauma-Informed Policy and Practice
Children and Adults with Attention-Deficit Hyperactivity Disorder (CHADD)
Clinical Social Work Association
Clinical Social Work Guild 49 OPEIU-AFL-CIO
Depression and Bipolar Support Alliance
Eating Disorders Coalition
EMDR International Association
Global Alliance for Behavioral Health and Social Justice
International Certification & Reciprocity Consortium
The Jewish Federations of North America
Legal Action Center
Mental Health America
NAADAC, the Association for Addiction Professionals
National Alliance on Mental Illness
National Association for Children’s Behavioral Health
National Association for Rural Mental Health
National Association of County Behavioral Health and Developmental Disability Directors
National Association of School Psychologists
National Association of Social Workers
National Association of State Mental Health Program Directors
National Health Care for the Homeless Council
National Multiple Sclerosis Society
National Register of Health Service Psychologists
Sandy Hook Promise
School Social Work Association of America
The Trevor Project
Treatment Communities of America

The Trevor Project is disappointed to learn of the Supreme Court’s decision to send transgender student Gavin Grimm’s case back to the lower appeals court. We, like many others, hoped this Title IX question would be settled once and for all and that no other transgender youth would have to engage in psychologically taxing litigation and scrutiny. We remain optimistic that the appeals court will again uphold their initial ruling that Title IX protects transgender students.

Steve Mendelsohn, the Interim Executive Director of The Trevor Project said, “Not being allowed to use the restroom or locker room consistent with one’s gender identity can cause significant psychological and social distress. In fact, research has shown a high correlation between transgender young people being denied the right to use the appropriate bathroom and suicidality. We are hopeful that the lower court will support their earlier decision which will contribute to the well-being of trans youth and reduce the likelihood of poor mental health outcomes in these populations.”